Radioactive iodine in the treatment of Graves' disease: history and modern concept of radionuclide therapy

Abstract

Radioactive iodine 131I is a theranostic isotope used both for diagnosis and therapy of benign thyroid diseases and thyroid cancer for 85 years. The formation of nuclear medicine is closely linked with the use of 131I. The history of radioiodine therapy began in 1941, when endocrinologist Saul Hertz for the first time used 131I to treat patients with Graves' disease. Since 1946 radioactive iodine 131I became widely available, and its effectiveness became public knowledge after reports on thyrotoxicosis treatment published in the Journal of the American Medical Association by multidisciplinary groups of scientists physicists and endocrinologists. In 1951, isotope 131I became the first Food and Drug Administration approved RP for the treatment of thyroid disorders. Around the same time on the basis of the First Moscow Medical Institute studies on the use of radioiodine isotopes in patients with thyrotoxicosis began. The head of the Soviet group on the studying of radioactive iodine was the physician-scientist Vera Georgievna Spesivtseva. The research works of medical physicists Edith Quimby and Leonidas Marinelli in optimizing therapeutic strategies using radioactive substances in the late 1940s and the wording of the ALARA (As Low As Reasonably Achievable) principle of minimizing exposure of ionizing radiation by the International Commission on Radiological Protection in 1954 contributed to the greater introduction of radionuclides into the medicine.

Topical Application of Perchlorate: A Toxicity Study in Rats

“…Frequently used for the treatment of some types of thyroid carcinoma, I-131(RAI) is known to have notable systemic side effects such as headache, gastrointestinal distress, bone marrow suppression, and gonadal damage. 3,4 Well-described ocular side effects include dry eye symptoms, [5][6][7] dacryocystitis, and epiphora due to nasolacrimal duct obstruction. 8,9 The proposed mechanism for the development of nasolacrimal obstruction has been described as absorption of the radioactive material by the sodium-iodide transporters (NIS) located in the stratified columnar epithelial cells of the lacrimal sac and duct, causing subsequent inflammation, which leads to fibrosis.…”